Perspectives of Expectant Women and Health Care Providers on Birth Plans

doi:10.1016/S1701-2163(15)30785-4

Journal of Obstetrics and Gynaecology Canada

Volume 35, Issue 11, November 2013, Pages 979-985

https://doi.org/10.1016/S1701-2163(15)30785-4 Get rights and content

Abstract

Objective

A birth plan is a document detailing a woman's preferences and expectations related to labour and delivery. Empirical research exploring the value of birth plans has shown conflicting findings about whether birth plans have a positive or negative effect on labour and delivery, suggesting a need for further study. This study aimed to understand the perspectives of women, health care providers, and support persons regarding the use of birth plans.

Methods

A cross-sectional questionnaire was distributed to a convenience sample of expectant or postpartum women, health care providers, and support persons from January 2012 to March 2012 in British Columbia.

Results

In total, 122 women and 110 health care providers and support persons completed the questionnaire. Both women and their attendants viewed the birth plan as being valuable for acting as both a communication and education tool. However, the respondents noted that women may be disappointed or dissatisfied if a birth plan cannot be implemented. The most important elements of a birth plan identified included pain management, comfort measures (e.g., mobility during labour), postpartum preferences (e.g., breastfeeding), atmosphere (e.g., privacy), and birthing beliefs (e.g., cultural views).

Conclusion

This is the first study to identify advantages and disadvantages of using a birth plan as well as the most important aspects of a birth plan from the perspectives of both women and their attendants in Canada. The findings could be applied to optimize the efficacy of birth plans in Canada and potentially internationally as well.

Résumé

Objective

Un plan d’accouchement est un document détaillant les préférences et les attentes d’une femme à l’égard du travail et de l’accouchement. Les recherches empiriques explorant la valeur des plans d’accouchement ont obtenu des résultats contradictoires quant à la question de savoir si ces derniers exercent un effet positif ou négatif sur le travail et l’accouchement, ce qui semble souligner la nécessité de procéder à d’autres études sur le sujet. Cette étude avait pour but de comprendre les points de vue des femmes, des fournisseurs de soins et des accompagnateurs à l’égard de l’utilisation de plans d’accouchement.

Méthodes

Un questionnaire transversal a été distribué à un échantillon de commodité de femmes enceintes ou ayant accouché, de fournisseurs de soins et d’accompagnateurs entre janvier 2012 et mars 2012 en Colombie-Britannique.

Résultats

En tout, 122 femmes et 110 fournisseurs de soins de santé et accompagnateurs ont rempli le questionnaire. Tant les femmes que leurs fournisseurs de soins et de soutien estimaient que le plan d’accouchement était utile à titre d’outil de communication et d’éducation. Toutefois, les répondants ont souligné que les femmes pourraient être déçues ou mécontentes dans les cas où la mise en oeuvre du plan d’accouchement s’avère impossible. Parmi les plus importants éléments du plan d’accouchement qui ont été identifiés, on trouvait la maîtrise de la douleur, les mesures visant le confort (p. ex. mobilité pendant le travail), les préférences postpartum (p. ex. allaitement), l’atmosphère (p. ex. intimité) et les croyances quant à l’accouchement (p. ex. aspects culturels).

Conclusion

Il s’agit de la première étude à identifier les avantages et les désavantages de l’utilisation d’un plan d’accouchement, ainsi que les aspects les plus importants d’un tel plan, et ce, tant du point de vue des femmes que de celui de leurs fournisseurs de soins et de soutien au Canada. Les résultats pourraient être utilisés aux fins de l’optimisation de l’efficacité des plans d’accouchement au Canada et (potentiellement) à l’étranger.

Section snippets

INTRODUCTION

Since their inception in the 1970s, birth plans have become increasingly popular in Western countries to improve advocacy for women’s autonomy during childbirth.¹,² A birth plan is a document detailing a woman’s preferences and expectations related to labour and delivery. The precise content of a birth plan varies, but may include preferences and expectations for obstetrical management, newborn care, conduct during emergencies, and cultural considerations.3., 4., 5. The aim of a birth plan is

METHODS

In Canada, pregnant women receive obstetrical care from family physicians, obstetricians, or midwives, and some women receive care from a combination of these providers. Women may also choose to be supported by a doula, most often paid for privately, during the labour process. Birth plan templates may be given to women by their care providers, or women may seek out birth plans online. The birth plans that are used can vary in their content, but typically include sections to be completed by the

RESULTS

A total of 122 postpartum or expectant women and 110 care providers and support persons completed the questionnaire. Most women (55%, n = 68) identified a midwife as their primary care provider, while only some women identified a family physician (27%, n = 34) or obstetrician (11%, n = 13) (Table 1). Most women (70%, n = 86) indicated that they had used or were planning to use a birth plan during their most recent pregnancy. The care providers and support persons identified a variety of roles,

DISCUSSION

This is the first study to report the advantages and disadvantages of using a birth plan, as well as the most important aspects of a birth plan from the perspectives of women, their care providers, and support persons in Canada. These results add important information in this area, and could be applied to develop an effective birth plan template that would be useful for women and their attendants.

Most of the women in the current study received their primary maternity care from a midwife, and

CONCLUSION

While many participants in this study indicated that a birth plan is a valuable educational and communication tool, the participants also acknowledged that a birth plan may promote a false sense of control or lead to disappointment if it is not fully implemented. Women emphasized the need to be flexible in making requests because a birth plan may not be implemented as desired. The study identified the important aspects of a birth plan that could used to help a woman develop or modify one.

ACKNOWLEDGEMENTS

The authors would like to thank those who participated in this study and the Fir Square Doulas of 2011-2012. Melissa Aragon, Amy Kluftinger, Riki Dayan, and Erica Chhoa were students in the Faculty of Medicine at the University of British Columbia when this study was conducted. This project was supported by the Family Practice Initiative Fund.

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Cited by (48)

Finding a way forward for the birth plan and maternal decision making: A discussion paper
2023, Midwifery
The role of birth plans for shared decision-making around birth choices of pregnant women in maternity care: A scoping review
2023, Women and Birth
Citation Excerpt :
For women, creating and discussing the birth plan with their partner and care provider seemed to contribute to more realistic expectations [23]. The knowledge gained through creating a birth plan was described in several papers as beneficial for women, allowing them to consider their options prior to birth, to become aware of hospital policies, and to address areas of concern [16,23,29,33]. One woman in the study of Aragon et al. mentioned: "…being prepared and educated increased success in everything we did.
Birth plans can be used to facilitate shared decision-making in childbirth. A birth plan is a document reflecting women's preferences for birth, which they discuss with their maternity care provider.
This scoping review aims to synthesize current findings on the role of birth plans for shared decision-making around birth choices of pregnant women in maternity care.
We conducted a scoping review using the Joanna Briggs Institute three-step search strategy in multiple databases PubMed, EMBASE, CINAHL, Web of Science, PsycINFO. We synthesized the results using a metasynthesis approach to identify themes and subthemes.
From the 21 articles included, five themes were identified: birth plan as a tool for shared decision-making, autonomy, sense of control, professionalism of the care provider, and trust. Primarily, midwives seemed to use birth plans to explore and facilitate women’s choices around birth. Other healthcare providers involved in studies were obstetricians and nurses. The interrelationship between care providers and women, the attitude of care providers and women towards each other and the birth plan, and how providers and women use the birth plan influence shared decision-making.
Birth plans can facilitate shared decision-making, and women’s sense of autonomy and control before, during, and after giving birth. When discussing the birth plan, exploring different scenarios may help women prepare for unforeseen circumstances. This will likely facilitate shared decision-making even if the birth process is not unfolding as hoped for.
Birth plans: definitions, content, effects, and best practices
2023, American Journal of Obstetrics and Gynecology
The first written guide for birth plans was introduced in 1980 as a means for birthing people to document their choices in the child birthing experience. The birth plan offers an opportunity for the patient and the provider to discuss the birthing process and determine how to safely accommodate patient preferences. Patient satisfaction with birthing plans is variable and may depend on how many requests they have, how many of their plans are accomplished, route of delivery, and whether complications arise during or after delivery. Unmet expectations may lead to posttraumatic stress disorder, but following a birth plan may also be protective against it. Birthing people who use a birth plan may be less likely to use epidural anesthesia, have early amniotomy, or use oxytocin. The first stage of labor may be longer when a birth plan is used; however, there does not seem to be a decrease in the length of the second stage of labor among patients with a birth plan. Some providers believe that a disadvantage of birth plans is disappointment when birth plans are not able to be followed, and others consider that birth plans interfere with professional autonomy.
Using a scheduled caesarean birth plan: A cross-sectional exploration of women's perspectives
2023, Women and Birth
There is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth.
Quality maternity care requires respect for women’s preferences. Evidence suggests birth plans enable communication of women’s preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome.
Explore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital.
A cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis.
Over half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women’s ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories.
Findings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment.
All women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.
Patient Satisfaction with Informed Consent for Cesarean and Operative Vaginal Delivery
2022, Journal of Obstetrics and Gynaecology Canada
To evaluate patient satisfaction with the informed consent process for elective cesarean delivery (CD), emergency CD, and operative vaginal delivery (OVD).
A cross-sectional, survey-based study was conducted among patients on the postpartum floor of our institution. Patients were approached after delivery to complete a previously pilot-tested questionnaire, based on validated literature. One hundred eighty-four surveys were included in the analysis. Levels of patient satisfaction were compared across modes of delivery using χ² tests of independence. Secondary objectives included evaluating the relationship between satisfaction scores and the patient’s recall of the consent process and emotional state during the consent process.
A significant association was found between patient satisfaction with the consent process and mode of delivery (P < 0.001). Those in the elective and emergency CD groups were significantly more likely to express high rates of satisfaction compared with those in the OVD group (odds ratio [OR] 9.03; 95% CI 2.80–29.10 and OR 3.97; 95% CI 1.34–11.76, respectively). High levels of satisfaction were significantly more common among those who had greater recall of the consent process (OR 25.2; 95% CI 7.34–87.04) and those who reported low levels of distress during the process (OR 15.1; 95% CI 4.70–48.66).
Informed consent during OVD is associated with lower rates of patient satisfaction compared with CD. Efforts are needed to improve the consent process for OVD to increase patient satisfaction and promote patient-centred care.
Évaluer la satisfaction des patientes à l’égard du processus de consentement éclairé pour la césarienne planifiée, la césarienne d’urgence et l’accouchement assisté.
Une étude transversale a été menée par sondage auprès de patientes de l’unité post-partum de notre établissement. Les patientes ont été approchées après l’accouchement pour répondre à un questionnaire fondé sur la littérature validée, lequel a préalablement été soumis à un essai pilote. Au total, 184 sondages ont été analysés. Le degré de satisfaction des patientes a été comparé pour chaque mode d’accouchement au moyen de tests d’indépendance du χ². Les objectifs secondaires étaient d’évaluer la relation entre les scores de satisfaction et le rappel par la patiente du processus de consentement et de son état émotionnel pendant le processus.
Une association significative a été observée entre la satisfaction de la patiente par rapport au processus de consentement et le mode d’accouchement (p < 0,001). Le taux de satisfaction était significativement plus élevé dans les groupes césarienne planifiée et césarienne d’urgence comparativement au groupe accouchement assisté (rapport de cotes [RC] : 9,03; intervalle de confiance [IC] à 95 % : 2,80–29,10 et RC : 3,97; IC à 95 % : 1,34–11,76 respectivement). Un niveau de satisfaction élevé était significativement plus commun chez les patientes qui se souvenaient bien du processus de consentement (RC : 25,2; IC à 95 % : 7,34–87,04) et chez celles qui ont rapporté un faible niveau de détresse pendant le processus (RC : 15,1; IC à 95 % : 4,70–48,66).
Le processus de consentement éclairé en cas d’accouchement assisté est associé à un plus faible taux de satisfaction des patientes qu’en cas de césarienne. Des efforts supplémentaires sont nécessaires pour améliorer le processus de consentement pour les accouchements assistés afin d’améliorer la satisfaction des patientes et favoriser les soins axés sur la patiente.
A machine learning approach to identifying pregnant women's risk for persistent post-traumatic stress following childbirth
2022, Journal of Affective Disorders
Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). Especially when persistent, PTS-FC may interfere with mothers’ caregiving and associated infant development, underscoring the need for accurate predictive screening of risk. Drawing on recent developments in advanced statistical modeling, the aim of the current study was to identify a set of prenatal indicators and prediction rules that may accurately identify pregnant women's risk for developing symptoms of PTS-FC which persist throughout the early postpartum period.
182 women from the general population completed a comprehensive set of approximately 200 potentially predictive questions during pregnancy, and subsequently reported on their acute stress and PTS-FC at three days, one month, and three months postpartum (self-report and clinician-administered interview). Based on the postpartum acute stress and PTS-FC data, women were classified into profiles of “Stable-High-PTS-FC” and “Stable-Low-PTS-FC” by means of Latent-Class Analyses. Prenatal data were modeled to identify women at risk for “Stable-High PTS-FC”.
Employing machine-learning decision-tree analyses, a total of 36 questions and 7 prediction-rules were selected. Based on a cost-rate of 15 versus 100 for false-negative “Stable-Low-PTS-FC” versus false-negative “Stable-High-PTS-FC”, the final model showed 80.6% accuracy for “Stable-High-PTS-FC” prediction.
This study identifies a short set of questions and prediction rules that may be included in future large-scale validation studies aimed at developing and validating a brief PTS-FC screening instrument that could be implemented in general population prenatal healthcare practice. Accurate screening would allow for selective administering of preventive interventions towards women at risk.

View all citing articles on Scopus

: Competing Interests: None declared.

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OBSTETRICSPerspectives of Expectant Women and Health Care Providers on Birth Plans

Abstract

Objective

Methods

Results

Conclusion

Résumé

Objective

Méthodes

Résultats

Conclusion

Section snippets

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

ACKNOWLEDGEMENTS

J Obstet Gynecol Neonatal Nurs

Obstet Gynecol Clin North Am

Midwifery

J Obstet Gynaecol Can

Int J Nurs Stud

J Midwifery Womens Health

Aust J Midwifery

Reg Anesth Pain Med

Birth plans: after 25 years, women still want to be heard

Birth

Letter from England-birth plans

Birth

Evolution of the birth plan

J Perinat Educ

Birth plans: are they really necessary?

Pro and con. MCN Am J Matern Child Nurs

Do birth plans empower women? Evaluation of a hospital birth plan

Birth

OBSTETRICS
Perspectives of Expectant Women and Health Care Providers on Birth Plans